Please take a few minutes to complete this survey. To ensure your anonymity, [Company Name] has retained an independent consultant to receive the completed questionnaires and interpret the finding
Using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree, please select one response for each statement.
| Overall Inclusion & Diversity Culture | 5 | 4 | 3 | 2 | 1 |
| The leadership at this company encourages diversity. | ° | ° | ° | ° | ° |
| Management shows that diversity is important through its actions. | ° | ° | ° | ° | ° |
| This company is committed to improving the diversity of employees. | ° | ° | ° | ° | ° |
| This company fosters a workplace that allows employees to be themselves at work without fear. | ° | ° | ° | ° | ° |
| This company respects individuals and values their differences. | ° | ° | ° | ° | ° |
| The leadership at this company treats all employees fairly. | ° | ° | ° | ° | ° |
| At this company, employees appreciate others whose backgrounds, beliefs and experiences are different from their own. | ° | ° | ° | ° | ° |
| Comments or suggestions for improvement: Using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree, please select one response for each statement. | |||||
| Hiring and Recruitment | 5 | 4 | 3 | 2 | 1 |
| This company takes active measures to seek a diverse candidate pool when hiring. | ° | ° | ° | ° | ° |
| There is diversity among the people a job candidate will meet/see on his/her first visit to the company. | ° | ° | ° | ° | ° |
| Comments or suggestions for improvement: Using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree, please select one response for each statement. | |||||
| Career Development | 5 | 4 | 3 | 2 | 1 |
| Employees of different backgrounds are encouraged to apply for higher positions. | ° | ° | ° | ° | ° |
| Employees of different backgrounds are treated fairly in the internal promotion process. | ° | ° | ° | ° | ° |
| There is a career development path for all employees at this company. | ° | ° | ° | ° | ° |
| | | | | | |
| Comments or suggestions for improvement: Using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree, please select one response for each statement. | |||||
| Personal Experiences | 5 | 4 | 3 | 2 | 1 |
| My experiences at this company have led me to become more understanding of differences among my coworkers. | ° | ° | ° | ° | ° |
| Getting to know people with backgrounds different from my own has been easy at this company. | ° | ° | ° | ° | ° |
| Comments or suggestions for improvement: Using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree, please select one response for each statement. | |||||
| Policies and Procedures | 5 | 4 | 3 | 2 | 1 |
| The company's policies or procedures encourage diversity, equity and inclusion. | ° | ° | ° | ° | ° |
| I am aware of and understand the procedures for reporting incidents of discrimination and/or bias in the workplace. | ° | ° | ° | ° | ° |
| I believe the company will take appropriate action in response to incidents of discrimination and/or bias. | ° | ° | ° | ° | ° |
| | | | | | |
| Comments or suggestions for improvement: Using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree, please select one response for each statement. | |||||
| Inclusion | 5 | 4 | 3 | 2 | 1 |
| Employees of different backgrounds interact well in this company. | ° | ° | ° | ° | ° |
| Management of this company demonstrates a commitment to meeting the needs of employees with disabilities. | ° | ° | ° | ° | ° |
| Employees of different ages are valued equally by this organization. | ° | ° | ° | ° | ° |
| Racial, ethnic, sexual and gender-based jokes or slurs are not tolerated at this organization. | ° | ° | ° | ° | ° |
| This company provides an environment for the free and open expression of ideas, opinions and beliefs. | ° | ° | ° | ° | ° |
| | | ||||
| Comments or suggestions for improvement: Using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree, please select one response for each statement. | |||||
| Your Immediate Supervisor | 5 | 4 | 3 | 2 | 1 |
| My supervisor is committed to, and supports, inclusion and diversity. | ° | ° | ° | ° | ° |
| My supervisor handles matters related to inclusion and diversity matters satisfactorily. | ° | ° | ° | ° | ° |
| Comments or suggestions for improvement: Using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree, please select one response for each statement. | |||||
| Diversity Training | 5 | 4 | 3 | 2 | 1 |
| This company has done a good job providing educational programs that promote inclusion and diversity in our workplace. | ° | ° | ° | ° | ° |
| | | | | | |
| Comments or suggestions for improvement: | |||||
| | | | | | |
What improvements, if any, can be made to improve the inclusion and diversity efforts at [Company Name]?
________________________________________________________________________
________________________________________________________________________
The following questions are voluntary and will be used for analytical purposes only. They will not be used to try to identify any individual.
How long have you worked for [Company Name]?
___ Less than one year
___ One year to less than two years
___ Two years to less than five years
___ Five years to less than ten years
___ Ten years or more
What is your age?
___ Under 21
___ 21 to 34
___ 35 to 44
___ 45 to 54
___ 55 or older
What is your gender?
___ Male
___ Female
___ Nonbinary
Which of the following best describes your role in the organization?
___ First-level supervisor
___ Manager/supervisor higher than first level (including senior management positions)
___ Not a manager or supervisor
Once you have completed your questionnaire, please return it using the enclosed envelope.
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